PB2706: NO DIFFERENCE IN SURVIVAL OUTCOMES BETWEEN IMMIGRANTS AND DANISH-BORN CITIZENS WITH A HEMATOLOGICAL MALIGNANCY: A NATIONWIDE, POPULATION-BASED REGISTER STUDY
Authors: Joachim Baech, Lasse Jakobsen, Marianne Severinsen, Mikkel Runason Simonsen, Henrik Frederiksen, Carsten Niemann, Judit Jørgensen, Søren Johnsen, Tarec El-Galaly
Journal: HemaSphere (2023)

Topic: 36. Ethics and health economics Background: Healthcare, including cancer care, is primarily tax-financed and access is free for all citizens in Denmark. The ability to navigate a modern, complex healthcare system may be challenged by socioeconomic position, level of health literacy, and language skills. Immigrants are often considered at risk of poorer cancer care due to language and cultural barriers possibly delaying diagnostic work-up and treatment. Ultimately, such differences could result in poorer overall survival (OS) for immigrants compared to Danish-born citizens. Aims: To compare OS between immigrants and Danish-born citizens with a hematological malignancy, and to identify patient characteristics possibly associated with OS differences. Methods: We identified patients with a newly diagnosed hematological malignancy (acute lymphoblastic leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, chronic myeloid leukemia, lymphoma, myeloma, or myelodysplastic syndromes) between 2000 and 2020 in the Danish nationwide hematological registers. Immigrants were defined as Danish citizens born outside Denmark. All citizens born in Denmark, and those immigrants with at least one Danish-born parent with a Danish citizenship, were considered Danish-born citizens. Second generation immigrants were excluded from this study. Patients were followed from diagnosis until death or censoring (31 December 2021 or emigration from Denmark), whichever came first. Crude and standardized OS was computed using flexible parametric models. Differences in 5-year OS were computed overall and by subgroups. Results: A total of 2,324 immigrants and 43,321 Danish-born citizens with a hematological malignancy were included. Half of the immigrants (52%) were of non-western origin and median age at diagnosis was significantly lower for immigrants compared to Danish-born citizens (61 years vs 70 years, respectively). Crude 5-year OS was 66.7% for immigrants compared to 56.9% for Danish-born citizens. However, when standardizing the results for age, sex, and hematological subtype, we found no significant difference in OS (5-year OS 56.7% vs 56.8%, respectively). When analyzing difference in 5-year OS by subgroups, we found a significantly higher 5-year OS for immigrants aged 61-80 years (2.7 percent points higher) and immigrants within the lowest income quartile (2.7 percent points higher) compared to Danish-born citizens after standardizing (Figure 1). There was no significant difference in OS in the remaining subgroups. Summary/Conclusion: We found no significant difference in survival outcomes between immigrants and Danish-born citizens with a hematological malignancy after standardizing for age, sex, and hematological subtype. The results suggest that the Danish healthcare system does not provide inferior care for immigrants with a hematological malignancy with regards to OS.Figure 1. 5-year overall survival differences in percentage with 95% confidence interval between immigrants and Danish-born citizens in different subgroups. * Standardized for age, sex, and hematological subtype ** Standardized for age and hematological subtype *** Standardized for sex and hematological subtype Abbreviations: SD = Survival difference, CI = Confidence interval Keywords: Epidemiology, Migration, Survival